Perilunate dislocations and fracture dislocations are rare, yet very grave wrist injuries that may easily be missed at the time of injury. They occur after high-energy trauma to the wrist.

The paper presents a variety of different types of perilunate dislocations, their inciden­ce, classification and mechanisms of injury. Initial clinical signs of injury may be quite modest. Important radiological signs include: a »signet ring sign« on the scaphoid, a triangular sha­pe of the lunate in the posteroanterior projection and a »spilled milk sign« in the lateral projection.

Surgical treatment combining the volar and dorsal approaches is required to provide an accurate review and identification of injured structures, to release the median nerve injury and reduce and internally fix the wrist bones.

Anatomic reduction of intercarpal relationships is the key to avoiding nonunion, malu­nion, or even avascular necrosis. Ligament repair or reconstruction − the volar ligaments and scapholunate interossal ligament in particular − is prognostically important, since it prevents chronic wrist instability and/or arthritis due to advanced scapholunate collapse.